scholarly journals Impact of cardiac resynchronization therapy on mitral valve apparatus geometry and clinical outcomes in patients with secondary mitral regurgitation

2017 ◽  
Vol 34 (11) ◽  
pp. 1561-1567 ◽  
Author(s):  
Christos G. Mihos ◽  
Evin Yucel ◽  
Romain Capoulade ◽  
Mary P. Orencole ◽  
Gaurav A. Upadhyay ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Clinical Outcomes ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Secondary Mitral Regurgitation

scholarly journals Transcatheter Mitral Valve Repair in Patients With and Without Cardiac Resynchronization Therapy

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Ioanna Kosmidou ◽  
JoAnn Lindenfeld ◽  
William T. Abraham ◽  
Saibal Kar ◽  
D. Scott Lim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Secondary Mitral Regurgitation ◽  
And Control

Background: In the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), treatment of heart failure (HF) patients with moderate-severe or severe secondary mitral regurgitation with transcatheter mitral valve repair (TMVr) using the MitraClip plus guideline-directed medical therapy (GDMT) reduced 2-year rates of HF hospitalization and all-cause mortality compared with GDMT alone. Whether the benefits of the MitraClip extend to patients with previously implanted cardiac resynchronization therapy (CRT) is unknown. We sought to examine the effect of prior CRT in patients enrolled in COAPT. Methods: Patients (N=614) with moderate-severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated doses of GDMT were randomized 1:1 to the MitraClip (TMVr arm) versus GDMT only (control arm). Outcomes were assessed according to prior CRT use. Results: Among 614 patients, 224 (36.5%) had prior CRT (115 and 109 randomized to TMVr and control, respectively) and 390 (63.5%) had no CRT (187 and 203 randomized to TMVr and control, respectively). Patients with CRT had similar 2-year rates of the composite of death or HF hospitalization compared with those without CRT (57.6% versus 55%, P =0.32). Death or HF hospitalization at 2 years was lower with TMVr versus control treatment in patients with prior CRT (48.6% versus 67.2%, hazard ratio, 0.60 [95% CI, 0.42–0.86]) and without CRT (42.5% versus 66.9%, hazard ratio, 0.52 [95% CI, 0.39–0.69]; adjusted P interaction =0.23). The effects of TMVr with the MitraClip on reducing the 2-year rates of all-cause death (adjusted P interaction =0.14) and HF hospitalization (adjusted P interaction =0.82) were also consistent in patients with and without CRT as were improvements in quality-of-life and exercise capacity. Conclusions: In the COAPT trial, TMVr with the MitraClip improved the 2-year prognosis of patients with HF and moderate-severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated GDMT, regardless of prior CRT implantation. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01626079.

scholarly journals Persistence of secondary mitral regurgitation and response to cardiac resynchronization therapy

2009 ◽  
Vol 11 (2) ◽  
pp. 131-137 ◽  
Author(s):  
F. Cabrera-Bueno ◽  
M. J. Molina-Mora ◽  
J. Alzueta ◽  
J. Pena-Hernandez ◽  
M. Jimenez-Navarro ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Secondary Mitral Regurgitation

scholarly journals The role of three dimensional transeosephageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart fail

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Demirtola ◽  
TS Tan ◽  
A Mammadli ◽  
IM Akbulut ◽  
I Dincer
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Purpose Cardiac resynchronization therapy (CRT) has  a positive effect on the improvement of functional mitral regurgitation in patients with low ejection heart failure. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to  the improvement of mitral regurgitation after CRT have not  been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods Thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included in the study. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results There were no significant changes in left ventricular EF and left ventricular diameters at the end of 3rd month, whereas ERO and RV values were decreased. A statistically significant difference was found in  posterior leaflet angle between mitral regurgitation responder and non-responder groups.  (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found to have lower posterior leaflet angle measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT. Abstract Figure.

scholarly journals The role of three-dimensional transesophageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart failure

2021 ◽  
Author(s):  
Ayse Demirtola ◽  
Turkan Tan ◽  
Anar Mammadli ◽  
irem Muge Akbulut ◽  
Demet Gerede ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Posterior Leaflet ◽  
Resynchronization Therapy

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Abstract 3073: The Impact of Baseline Mitral Regurgitation on 1-Year Clinical Outcomes in Patients Undergoing Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kenji Ando ◽  
Yoshimitsu Soga ◽  
Shinichi shirai ◽  
Koyu Sakai ◽  
Masahiko Goya ◽  
...  
Keyword(s):  
Survival Rate ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Clinical Outcomes ◽  
Nyha Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Event Free Survival ◽  
Free Survival ◽  
The Impact

Background: The impact of mitral regurgitation (MR) on long-term clinical outcomes in patients (pts) undergoing cardiac resynchronization therapy (CRT) is not well established. Methods: We investigated 110 pts received CRT (age 71+/−10years, NYHA class 3.1+/−0.5, LVEF 26+/−7%, LVEDD 61+/−7mm, pre QRS duration 178+/−29ms) and divided into two groups, 40 pts with baseline MR grade 0 –1 (less MR group) and 70 pts with baseline MR grade 2– 4 (severe MR group). 1-year clinical data were obtained. Results: Baseline clinical and echocardiographic characteristics were similar between two groups without baseline MR grade (0.9+/−0.3 in less MR group vs.2.2+/−0.5 in severe MR group, p<0.0001). At 1-year follow up, NYHA functional class was significantly better in less MR group than severe MR group (1.9+/−0.8 vs.2.4+/−0.6, p=0.0004). Event free survival rate from heart failure hospitalization (HFH) was significantly higher in less MR group compared to severe MR group (93% vs.75% at 1 year, Log-rank p=0.037) and event free survival rate from combined death and HFH was also significantly higher in less MR group (87% vs.69% at 1 year, Log-rank p=0.039). Conclusion: Pts with severe baseline MR had worse clinical outcomes even if received CRT compared to less MR pts.

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